*NOT PREGNANT JUST THINKING AHEAD* Midwife vs. OB GYN...Thoughts?

StephyM89

One of my biggest coping strategies with the waiting game (especially while doing fertility treatment) is to plan...plan...plan! haha

The thing on my mind right now as we are TTC is whether to go with a midwife or OB GYN for prenatal care. As I look into it, a midwife is definitely becoming more and more intriguing, but I really don't have a lot of information about it. Any information, experience, or advice would be very helpful!

What are you deciding and why?  

Lulucooks

I will be having a repeat C-section so I'll go the OB route.

Kay6519

As most of these women have never been pregnant (hence the Trying to Get Pregnant board), this question is better suited to the first and second trimester boards.

StephyM89

Kay6519 said:

As most of these women have never been pregnant (hence the Trying to Get Pregnant board), this question is better suited to the first and second trimester boards.

Fair enough! I will try those boards. I have never been pregnant either, so I thought that maybe some people might be looking into the same thing, and might have the same questions as I do. Maybe I will re-post though! 

I genuinely appreciate your input, thank you! 

StephyM89

Lulucooks said:

I will be having a repeat C-section so I'll go the OB route.

That definitely makes sense, and in the event that a C section is needed, is one of the reasons that I have strongly considered the OB route. 

SweetiePateetie

I don't think it's an inappropriate question. I will be going the midwife route.  It's how my mom delivered us and we have a wonderful program here in our neighborhood. 

virginiaham

I also don't think this question is inappropriate.  It's a huge personal/medical decision and I think that knowing/thinking about birth options is not cart before the horse.

If it's a safe option for me, I'm absolutely game for midwife and birth center for a lot of reasons but my H is not.

If you're looking for more information on midwifery, I'd recommend starting with Ina May Gaskin's Guide to Childbirth and Netflix has a series called "The Business of Being Born" that I thought was really informative in a really accessible way. // eta There is also a well-researched book titled Pushed that examines modern childbirth/maternity care practices if you want to peer into the birthing industry as a whole.

LoveIsOwlYouNeed

I had a midwife. They were actually a larger practice that had OBGYNs in one office and a handful of midwives in the office across the hall. I liked that because they had the close association with the doctors in case the need for an MD arose, which it did in my case as I ended up having a C section. If that possibility is available to you, I suggest it. Best of both worlds. 

Megzb510

Lulucooks said:

I will be having a repeat C-section so I'll go the OB route.

^^this^^   I've already discussed whether I would be looking a repeat C-section and she said based on how my birth didn't progress the first time due to scar tissue from LEEPs, it's unlikely I would dilate next time. So repeat c-section with an OB.

picklesplease

Just whatever you do...don't get a midhusband. Midwives are better. 

LadyMillil

If I have a low-risk pregnancy I'm planning on going the midwife route. The midwives here do delivery at the local hospital which I like in case there are problems. I have 3 friends that all had babies around the same time. 2 used midwives and 1 had an OB. I know it is dependent on care providers, location, pregnancy/baby stuff etc but the ones that had midwives said the experience was positive, they felt informed, empowered, and that their desires mattered whereas the one with the OB felt rushed and like what she wanted didn't matter.

NurseMarie9

At this time, I am all for the OB route. Personally, I have heard too many horror stories about midwives & birth centers in my area. But I'm keeping an open mind and when I finally get KU, I'll do more research about both before deciding on one.

britters314

I know I'm going to look into both (though I have a medical issue that will probably mean an OB is safer). From what I've read there are differences in education levels that different types of midwives have and I believe a nurse-midwife is the best. Some midwives work in hospitals, which means you can deliver there and a doctor can take over if you need a C-section.

mrsstuessy

Where I live there are tons of hospital midwives, so it would be pretty similar to an OB. If something did come up there would definitely be an OB around to do a c-section. What I would recommend is meeting with both and seeing what sort of vibes you get. That might help you choose. I am a birth doula, so of course I need to recommend looking into that, especially if you choose the OB route. It is sort of the best of both worlds. 

TheBorg7of9

Midwife at a hospital is the way I like to do it. If you have an OB, they just show up for the pushing part anyway. It's really the nurse on duty at the hospital that is with you all the way and you can't choose who that will be. When I had a midwife, she checked on me more often snd didn't push interventions, etc. A midwife at home or a birthing center is way too risky for my taste. You would think if there were an emergency that you could easily get to the hospital in time, but if there were a real emergency it would take much too long to get there. You need to get help with in seconds if something goes wrong with the birth. 

juliehollz13

Good question, i was just thinking about it today - I spend so much time learning about everything that could possibly affect TTC that I have no clue what i'm going to do after i get a BFP. i think i will go the OB route because it would be my 1st baby but Im thinking of hiring a doula because DH has the worst bedside manner. Lol. He is a total midhusband. 

ChaoticWolf

I'd like to go with a birth center so bad but because of my bmi, unless I lose 50 lbs before I get KU I won't be able to.

CajunSnowWhite89

I'm going to use an Ob/gyn. Not for any particular reason, I just always thought that was how it's always done and I grew comfortable with the idea. Now that I know there are other options I still feel most comfortable with an OB at a hospital. 

hanshotfirst77

I'm going to use my OB again. I was very happy with my care with my DS so I have no reason to want to change things up. He works in a group so I ended seeing everyone in the group at some point and one was even a midwife. 

cjt121413

Another repeat c-section girl here. So it'll be my Ob, who I actually really like.

mrsdee15

OB/Gyn because of my insurance, and I'm very comfortable with them.  Incidentally, should I get KU, I'll give birth at the same hospital where I was born.

rkstro2

Should I ever be lucky enough to be KTFU I will deliver at a hospital with a NICU. 

MamaMunn

I plan on delivering in a hospital with an OBGYN. Actually I hope to deliver at the hospital I work at because I know many of the L&D nurses and they are amazing. It is a 25 minute drive though and there is another hospital only a block from my house. So I think that is something DH and I would discuss if we ever get KU. 

princesslockness

I will be trying for a VBAC, and have an increased risk of GD and eclampsia. So, OB for me. I might have to really fight my insurance, but I'd like the same one for #2 as for #1.

hupp0013

*TW former pregancies mentioned*


I met with a midwife at a clinic and really liked her.  She was associated with a hospital that had the ability to do a c section should the need arise.  My cousin had her as a midwife and ended up needing a c section.  I like a practice where you have those options (which are a lot of them.)

I used a family practice doctor who was certified and able to do c sections when I was pregnant with my first.  I went this route so he could be my doctor and the baby's doctor. I ended up needing a c section and he was able to do everything I needed.  I will need a repeat c section and have moved to a different area since my first pregnancy and will use the OB that I used for my second baby.

zrain

100% midwife. I dislike how pregnancy and birth, even low risk, in a hospital is treated like an illness instead of a natural part of life that women have been doing forever. Also, I work in a hospital so I see how often procedures and tests and whatnot are pushed on people without thorough discussion. Maybe that doesn't happen everywhere, but I don't want to have to deal with that during labor unless I have to.

**TW loss**


When I was pregnant I found a wonderful midwife who does birth center and home births, and they didn't make you decide which til 32 weeks or so. She was amazing. The birth center offered every test an OB's office would and had its own ultrasound machine, emergency equipment, nitrous oxide, etc. plus it was 7-10 minutes away from three hospitals. When I found out I was going to miscarry my midwife gave me her cell number so I could call and text her with questions and updates throughout the process. It was a huge help. She also told me that when I get another BFP to give her a call that same day so I can set up an appointment and we can do whatever I need to feel comfortable with PGAL. I'm so glad to have her and would not want anything else.

NamelessAria

I honestly had never really considered using a midwife till I binge watched the BBC show "Call the Midwife." After that I found the midwife idea strangely appealing. So I looked into outcomes with OB vs. midwife and all this. Apparently if you're low-risk it usually doesn't matter which you choose. Like a lot of ladies here have said a lot of studies found the patients felt more informed and empowered with a midwife vs. an OB.

However, my insurance will cover most of the birth and related expenses (my OOP would be around $3000-4000 dollars based off the estimate) but won't cover anything at all for a home birth and covers little or nothing for a birthing center. So what I'll probably do is have a midwife at a hospital. Unless of course I end up being high risk for some reason and then I'll obviously go the OB route. My OB practice said they tend to consider women with Endo high risk (though no one explained why) so the office I'm using at the moment may term me "high risk" because of Endo. I guess I'll see what happens if I ever make it to that point.

I do know that for the birth plan I don't want to have the cord clamped and cut till it's been ~5 minutes and it's done pulsing and such. I saw an excellent TED talk on that and it seems like such a simple thing that could possibly help baby a lot.

I've tried not to think too much about all this because I feel like it's a bit cart before the horse. DH won't talk about it at all because he feels it's extremely cart before the horse.

ETA: My OB/GYN office has a policy where you have to pay a "labor and delivery deposit" no later than 3 months into your pregnancy if you want to use them so if/when I get another BFP this is all something I'll have to think about fairly immediately since I'm not going to pay a non-refundable deposit and then switch providers.

atcwag

Unfortunately, this decision has been made for me because I live in a small town/work for an independent hospital with no midwives. There are actually only 2 OB practices (5 Drs total I believe) to choose from. I have recently wondered if I could get my insurance to pay for a midwife at the hospital about an hour away since my in-network doesn't offer that service. Not really sure it's a fight I want to get into. As a medical professional, I also would never do anything but a hospital birth. 

slradske0626

I plan on having a natural home birth with a midwife, assuming that my future pregnancy remains low-risk. Hospitals make me very uncomfortable, and to me seem like a place for the sick and injured. I don't see a birthing mother as either of these things. I trust my body and I think the individualized care of a midwife is what will work best for DH, our future child, and myself. I also agree with a PP, The Business of Being Born is an awesome documentary, definitely give it a watch! 

Neikoda

Unfortunately as soon as I get PG again I would be considered high risk so I have to work with my OB/GYN and MFM since during birth I'm at risk for hemorrhaging and blood clots. 

zrain

atcwag said:

Unfortunately, this decision has been made for me because I live in a small town/work for an independent hospital with no midwives. There are actually only 2 OB practices (5 Drs total I believe) to choose from. I have recently wondered if I could get my insurance to pay for a midwife at the hospital about an hour away since my in-network doesn't offer that service. Not really sure it's a fight I want to get into. As a medical professional, I also would never do anything but a hospital birth. 

It's really interesting to me how differently healthcare professionals view hospital births. I completely agree that a hospital would be the safest place to give birth if you are high risk or if anything went wrong, yet the idea of giving birth in a hospital scares me. From what I've heard about hospital births in my area at least, you are very restricted. Unnecessary continuous monitoring and fall risk protocols limit the mamas ability to walk around as much as she wants. They often restrict food and fluid intake in case of need for anesthesia despite such restrictions not being evidence-based. There is a lot more pressure put on the mama for inductions and c-sections if things are not progressing quickly enough, as well as other interventions such as episiotomies and use of forceps. There's also the increased risk of nosocomial infection that accompanies any hospital stay. That being said, birth center and home birth do have higher risk if there is a complication, because as @TheBorg7of9 said, if there's a real emergency, a 10 minute transfer to a hospital is too long. I guess I'm willing to take that small risk over the many other risks of a hospital birth and rely on my midwife team to properly assess and transfer to a higher level of care early before it becomes an emergency. I'm not in any way saying you or anyone else is wrong, because everyone has their preferences and methods of weighing the pros and cons of any situation. This is the information I've gathered and how I've applied it to what is important to me, and I'm interested to hear other healthcare professionals' reasons for going the hospital route.

ETA I also think I'm biased because my brother and I were born at home, as well as my niece and nephew, and my SIL is a home birth midwife. I also never got to see a birth during my maternal child clinical so I don't have any personal experience with hospital birth and would like to hear a more informed opinion!

izza2

I love our OB floor and the ladies up there, so no matter what I'm giving birth there. I like my OB, but I'm going to look in to the midwife options in the area more when we do end up TTC again, and when we eventually get pregnant. I have a nagging feeling that there aren't a lot of midwives with rights to our hospital, but, it's worth looking in to some.

wintersong

It's not always either/or.
I go to a collaborative practice with obs and midwives. I see a midwife (or nurse practitioner for gyn), but there are also obs on the practice in case things become...complicated. 

******TW: previous pregnancy




Even when I developed preeclampsia, I still delivered with my cnm. The obs working for the practice just kind of came on team and advised the midwives what they wanted them to do once I became higher risk. It was great because I got all the benefits of midwife care but with the assurance of ob care from a team I knew in case things went different from plan. (Outcome: I was induced at 38 weeks per the obs insistence, and everything from inserting the cervadil to the pushing phase was totally handled by the midwives in team. I ended up with a vaginal birth after 24 hits of labor.)  

wintersong

Hospitals don't have to be scary. The hospital that I have birth in was designated baby friendly--they really protect the breastfeeding relationship. It's not like they won't use formula, just that yet avoid practices that tend to sabotage the relationship, like taking baby away during first hour, sending home tons if formula samples, etc. It was so nice to be in a warm place with my husband with all my meals cooked for me with a lactation consultant down the hall for tyre first day with my baby. The only real down side to the hospital during my stay was the constant interuptions, lol. Who can sleep in a hospital??

YogaSandy

My hospital experience was amazing. My nurse was so wonderful - I can't say enough good things about her. My doctor was great. He offered (and had I known better, I would have taken him up on it) us to stay an extra day so we weren't rushed home. 

I went in about 36 hours before birth with extremely high (spiked) blood pressure. Everything was my choice. Nothing was pushed on me. Now, I was a crying scared mess. Because DH was away for work (to a remote fly in community), we weren't sure if he would be home in time. His work made sure he was. I was scared and alone (even though my mom was there) so for the most part, when my doctor gave me options, I just told him whatever he felt was best. 

I also live in Canada, so I know our health care is different. 

HeartMama2013

***TW - Previous pregnancy***


My hospital birthing experience with my DD was horrific. But not because of the hospital. The on call OB let my push for 4.5 because I really wanted a vaginal birth. She was just not moving in the birth canal. Her head was stuck. In the end, I had a placental abruption and my daughter was born with a critical heart defect that was undiagnosed until birth. THANK GOD I delivered in a hospital. We both could have died if we hadn't. 

I will be using the same OB that I used with my DD. She visited me several times during the day when I was in labor, even though she was in clinic and not on call. After the clinic was closed, she came up to me and never left until after I woke up from the c-section, 2 hours after my DD was born. She wanted to tell me how every thing went personally. I will love her forever for that. 

DiFazette

I will have a cesarian again and need to deliver at a hospital that has a level IV NICU since I won't be allowed to carry to term.  We'll have a preemie no matter what, just hoping for 36+ weeks.

atcwag

zrain said:

atcwag said:

Unfortunately, this decision has been made for me because I live in a small town/work for an independent hospital with no midwives. There are actually only 2 OB practices (5 Drs total I believe) to choose from. I have recently wondered if I could get my insurance to pay for a midwife at the hospital about an hour away since my in-network doesn't offer that service. Not really sure it's a fight I want to get into. As a medical professional, I also would never do anything but a hospital birth. 

It's really interesting to me how differently healthcare professionals view hospital births. I completely agree that a hospital would be the safest place to give birth if you are high risk or if anything went wrong, yet the idea of giving birth in a hospital scares me. From what I've heard about hospital births in my area at least, you are very restricted. Unnecessary continuous monitoring and fall risk protocols limit the mamas ability to walk around as much as she wants. They often restrict food and fluid intake in case of need for anesthesia despite such restrictions not being evidence-based. There is a lot more pressure put on the mama for inductions and c-sections if things are not progressing quickly enough, as well as other interventions such as episiotomies and use of forceps. There's also the increased risk of nosocomial infection that accompanies any hospital stay. That being said, birth center and home birth do have higher risk if there is a complication, because as @TheBorg7of9 said, if there's a real emergency, a 10 minute transfer to a hospital is too long. I guess I'm willing to take that small risk over the many other risks of a hospital birth and rely on my midwife team to properly assess and transfer to a higher level of care early before it becomes an emergency. I'm not in any way saying you or anyone else is wrong, because everyone has their preferences and methods of weighing the pros and cons of any situation. This is the information I've gathered and how I've applied it to what is important to me, and I'm interested to hear other healthcare professionals' reasons for going the hospital route.

ETA I also think I'm biased because my brother and I were born at home, as well as my niece and nephew, and my SIL is a home birth midwife. I also never got to see a birth during my maternal child clinical so I don't have any personal experience with hospital birth and would like to hear a more informed opinion!

*Possible TW - birth story*

@zrain - I don't disagree with anything you've said. For me, I'm strong and an advocate for myself. Often hospitals practice the things you've mentioned (including where I work/delivered/will deliver), but if you ask to see the actual policy on things that are important to you, it's often a different story on IF these are necessary the majority of the time. I am very up front with my Dr and nurses about how I want to labor, and they are compliant with the as long as it's not "officially" against policy. 
Unfortunately, I had to be induced with DS due to gestational hypertension (after fighting induction and monitoring X 2 weeks), so I had many more interventions than I would have liked. In the absence of that, I think the key is laboring at home as long as possible. Walking in at 7 or 8 cm doesn't leave time for interventions. 
With all of that said, I just can't take the "what-if" factor. I have too many friends and myself who've had birth complications. I am fully aware that my complications may have been caused/exacerbated by induction. I get really, really sad when I think about it, but it became a necessary intervention I never wanted. In the end, I almost had a CS. No position in the world was bringing DS down the birth canal with, what we found out, was cord wrapped head and body. Fortunately, my Dr. was excellent and, with some suction, was able to deliver him. 
Anyway, this was way longer than I expected. It's something I feel strongly about. Others have the opposite view, which is ok too!  I just don't think hospitals have to be filled with inevitable interventions if mama/daddy/support person are advocates for themselves/mama/baby. 
PS...My hospital doesn't have a birth pool which I would totally love! I'm not sure if they allow laboring in the shower or not...I didn't have the opportunity with DS and didn't ask since I didn't plan on arriving with enough time to do so. 

hbomb513

LoveIsOwlYouNeed said:

I had a midwife. They were actually a larger practice that had OBGYNs in one office and a handful of midwives in the office across the hall. I liked that because they had the close association with the doctors in case the need for an MD arose, which it did in my case as I ended up having a C section. If that possibility is available to you, I suggest it. Best of both worlds. 

This. I would have loved to just give birth in a birthing center with a midwife, but then I became a nurse. And worked in a NICU. I understand I see the 1% or whatever, but knowing what I know now, I would never give birth anywhere that didn't have at least a level 3 NICU, and multiple OB's on staff that can perform emergency C sections if needed. Things can change SO quickly in the birthing process, and I want those resources readily available.
That being said, I'm also a big fan of MOST of the information on Business of Being Born and an advocate of using the least amount of interventions necessary. It would be my perfect scenario to be in a place where midwives ruled the house and OB's were there for backup. Personally, I plan on having a clear birth plan (that DH is both familiar and on board with), and then changing it as necessary, not convenient.

gardeniagirlknits

When we first decided to try I did all this research re: midwives/ob.  I thought we'd Be pregnant right away (ha!  Over a year later...)

Like a pp suggested,  I read Ida May Haskins book.  I also read a book called How to have a natural birth in a Hospital. I also purchased some books about husband coached birthing.   (sorry I can't remember the titles Exactly...  I've since given these books away because well... When I got cancer I was in a dark place).  I highly recommend all three.  I feel the hospital natural birth one and husband coached books were more relatable and Most people I know feel the same. (side note... I love Ida may,  but...  She is a bit Hippy dippy and That can rub some people wrong. Would I like to give birth on a farm?  You betcha!  Is this going to happen?  No.  We don't live even remotely close to her farm.  Nonetheless,  I found the book empowering and informative.) 

I used to have kaiser through my work and I hated their ob model.  Basically  you didn't get to pick who delivered you.  It was whoever was at the hospital at the time.  And every friend/Co worker  that went this route seemed to be displeased.  So DH and I decided when the time Came,  we would pay the 5,000 or so OOP to go to the well known midwifery center. (at his work,  at the time,  I was not allowed on his insurance if my company offered insurance.  I am no longer working so now I am on his insurance and I think they will help with a midwife,  financially) 

Now after having my thyroid removed and a host of issues with  my medications for that,  I'm not sure this is an option for me.  I haven't done any research yet bc I honestly don't feel I will get pregnant (and now fertility drugs are largely not available to me bc of my cancer hx) so I don't even let my mind wander there.  

Ideal?  Home Birth.
Compromise with DH ideal?  Midwifery center.  
More likely after cancer?  Ob. (my current ob also had thyroid cancer so we're very bonded...  This makes me feel better about this option) 
Most likely? Adoption. 

And at this point...  I'll take whatever  

meilay

I've looked into this also, even before TTC. Ideally I would want a home birth but DH would be a bit too freaked out by that. So we're going to go the birth center with midwives option when that time comes. I have Kaiser and some of their local hospitals are trying to change their labor/delivery model to be more midwife centered but from the research I've done I'd have to travel close to an hour away to use the location that truly has the model down and the location closest to me is not quite there yet. Although I know hospital birth doesn't have to be scary, I'm terrified of hospitals and would just prefer to birth elsewhere when that time comes. Of course, all of this goes out of the window if it doesn't end up being what's best for me or baby.